Panel 2 InfoButtons and Meaningful Use

Infobuttons and Meaningful Use
Guilherme Del Fiol, MD, PhD University of Utah, Moderator and presenter

  • Glycemic Management in a Patient with Type 2 Diabetes — NEJM NEJM 2013; 369:1370-1372 – case vignette
  • Clinician Info Needs
    • 20 patients a day
    • 12 info needs
    • 6 pursued
    • 4 meet
    • 4 = treatment alternatives
  • Reasons why info needs are not met
    • no time
    • doubt answers exist
    • not urgent
    • referred to specialist
    • deferred and forgotten
  • Positive impact on info seeking
  • 2-3 minutes max time spent searching
  • Implications
    • 60% of info needs not met
    • not getting better: less time, complex patients and knowledge
    • missed opportunity for improved care and lifelong learning
  • Informatics opportunities
    • efficient tools (30s-1m timeframe)
    • decision under complexity
    • EHR to become a learning environment, not just a documentation burden
    • integrate with maintenance of certification/CE
  • 1995 – release date for Columbia; 2002- Intermountain
  • Impact of Infobuttons
    • answers to 85% of questions
    • decision enhancement or learning in 62% of sessions
    • median session time: 35s
    • User satisfaction (69% to 92%)
    • Slow but growing usage (Partners Healthcare ~100k sessions/month
  • EHRs
  • Implementations
  • References

Nathan Hulse, PhD – Intermountain Healthcare

  • URL-based
  • primary effort on ‘developer’s side’ is to populate the right data points
  • content provided as metadata or presentation layer
  • launching PHR infobutton – this arena raises new questions regarding greater contextual question, reading level
  • Supported infobutton resources
      • local content
      • genetic home reference
      • gene review
      • Cochrane
      • MerckIndex
  • Resource selection considerations
    • clinical
    • usage patterns
      • how many hits
      • where are they originating from
      • cost per click
      • unique users
    • overall cost
    • perceived value
    • CME credit integration
    • Overlaps in content coverage
  • Achieving meaningful use
    • integrating infobuttons in multiple, overlapping systems
    • ‘documenting’ that education materials were given
    • new coverage in areas like imaging, allergies, and other domains

Consumer Health Information and InfoButtons
Leslie Kelly Hall, Healthwise

  • infobutton more contextually relevant as it is in workflow
  • provides conversation shift from where to find things to relevancy review of articles

Stratton Lloyd, BA – EBSCO Information Services

  • new model for aggregating content
    • actionable content, contextual searching, integrating into tools
    • Point of Care tools
      • PEMSoft
      • Nursing Reference Center
      • Social Work Reference Center
  • Content access via EMR/EHR
  • 2 key content sets: patient education  vs clinical reference content
  • patient ed requires significant effort in EMR system, but clinical reference does not

Overall, infobuttons are just getting on the roadmap for EHRs

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